VA doctors tell of opiate pressures

Department of Veterans Affairs physicians told a House subcommittee today that hospital administrators regularly pressured them to prescribe highly addictive narcotic painkillers to patients, even those they had not personally examined.

The hearing marked the first time VA officials have spoken publicly about the skyrocketing number of painkiller prescriptions since The Center for Investigative Reporting revealed the trend last month.

“There are multiple instances when I have been coerced or even ordered to write for Schedule II narcotics when it was against my medical judgment,” said Dr. Pamela Gray, a physician who formerly worked at the VA hospital in Hampton, Va.

Primary care doctors who don’t want to prescribe large amounts of opiates may resign, do as they are told or be terminated, Gray said. Gray was fired.

In his testimony before the health subcommittee of the House Committee on Veterans’ Affairs, the VA’s principal deputy undersecretary for health, Dr. Robert Jesse, said the large amounts of opiates prescribed at VA hospitals and clinics are part of a national crisis that extends beyond the agency.

Jesse said that if physicians feel pressured by their superiors to prescribe, that is “absolutely indefensible” and they “should feel absolutely that they can refuse to do that.”

But lawmakers were not convinced. “The system appears to be broken,” said Rep. Julia Brownley, D-Calif., the subcommittee’s ranking Democrat. “How do you respond to the comments that we have a system of quick and cheap over good and thorough?”

Jesse responded: “I don’t believe that is the case systemwide.”

CIR disclosed that prescriptions for four highly addictive opiates – hydrocodone, oxycodone, methadone and morphine – have increased by 270 percent since the war in Afghanistan began, far outstripping the increase in the number of patients.

In its analysis, CIR also found extreme variation in the rate at which agency doctors prescribed these opiates around the country. Last year, for instance, doctors at the VA hospital in Roseburg, Ore., wrote eight times as many opiate prescriptions per patient as did their colleagues at the VA hospital in Manhattan.

“Veterans depend upon VA to uphold its mission of restoring the health of those who have borne the burdens of battle,” Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans’ Affairs, said in his opening statement.

“But instead of helping them manage their battles with pain in a healthy manner, VA has opted instead to use treatment that has the power to destroy, rather than restore their lives,” Miller said.

Veterans and survivors of former servicemen who had died of opiate overdoses testified at the hearing.

Iraq and Afghanistan war veteran Scott Alan McDonald died of an overdose of Percocet on Sept. 13, 2012. His widow, Heather McDonald, who was featured in a CBS News report on painkillers last month, told the lawmakers that families can accept a soldier’s death on the battlefield but cannot accept “when they come home and die in front of their children and their loved ones.”

Correction

An earlier version of this story misstated when Scott Alan McDonald died.